Provider First Line Business Practice Location Address:
EAST CAMPUS OFFICE BUILDING
Provider Second Line Business Practice Location Address:
MEDICAL CENTER DR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-6772
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2018